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General Surgery Coding Alert

Gastric Bypass:

Don't Count on Obesity for Medical Necessity

Look for co-morbid factors too. If your surgeon wants to get paid for bariatric surgery, you need to cross all your "T's" and dot all your "I's." Medicare and other payers that follow CMS guidelines require lots of documentation -- and even certification -- to let you get the job done. Document Obesity and Treatment First, you'll need ICD-9 documentation of morbid obesity. "Based on the medical record, you should list the primary diagnosis as 278.01 (Morbid obesity), and a secondary diagnosis code from category V85 (Body Mass Index [BMI]) indicating a BMI greater than or equal to 35," says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, audit manager for CHAN Healthcare in Vancouver, Wash. In addition to documenting obesity, the medical record must also demonstrate that the patient has previously been unsuccessful with the medical treatment of obesity. Add Co-Morbid Diagnoses Obesity and failed treatment alone won't justify [...]

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